Provider Demographics
NPI:1538599972
Name:MARTH, KIM MARIE
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:MARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-3033
Mailing Address - Country:US
Mailing Address - Phone:715-423-0915
Mailing Address - Fax:
Practice Address - Street 1:940 16TH ST N
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-3033
Practice Address - Country:US
Practice Address - Phone:715-423-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178493-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse